Welcome From The Chair

Rainu Kaushal, M.D., M.P.H. Professor and Chair

The Department of Healthcare Policy & Research, formerly Public Health, concentrates on studying and improving healthcare delivery to optimize the value of healthcare for patients in New York and across the country. It is chaired by Dr. Rainu Kaushal, an expert in healthcare quality, patient safety and information technology.

Dr. Dhruv Khullar: With Drugs, How Do We Base Their Medical Value vs. Out-of-pocket Cost?

How much should your medicine cost?

A physician colleague recently told me the story of a patient who asked if she could put off taking her medication until the end of the month, after she received her paycheck. The price had risen and she didn’t have the money to pay for it along with her other bills. Unsure how to respond, he gave her $20 to cover part of the cost.

Dr. Ravi Sharaf: A Letter to our Daughter.

You close your eyes when the doctors walk into your hospital room, and we wish we could do the same. Our hearts are empty without you at home. We invite your older sister into our bed at night to hold her close to comfort ourselves and remind her, despite her feelings otherwise, that she is still part of the family in spite of the time we devote to your care. We would do anything to take away your pain, to suffer your illness in your place, to give our life for yours.

Dr. Dhruv Khullar: A Profusion of Diagnoses. That’s Good and Bad.

I recently cared for a hairdresser who had gone through a year of vague and varied symptoms. What started as a few unpleasant aches soon became debilitating pain throughout her body. A heavy fatigue settled into her bones: Holding scissors or sweeping the floor became too much. She slept fitfully; her memory flagged. Frustrated by many symptoms and few answers, she grew anxious and depressed.

Dr. Art Sedrakyan’s study, published in JAMA Cardiology, found that hospitals maintaining their aortic valve surgical expertise had the best track record for patient survival after transcatheter aortic valve replacement (TAVR).

Brian LaGrant, a Weill Cornell second year medical student, presented his research to a national audience at the Child Neurology Society annual meeting in Chicago, IL on October 17, 2018.

Brian analyzed the National Survey of Children with Special Health Care Needs to understand the prevalence of psychiatric co-morbidities in children with epilepsy. He found that 25% of children with epilepsy have either depression or anxiety, highlighting the importance to screen for these disorders. Brian conducted his research under the mentorship of Dr. Zachary Grinspan, Weill Cornell Departments of Healthcare Policy & Research and Pediatrics, as well as with co-authors Dr. Oyinkan Marquis from Weill Cornell Pediatrics and Professor Anne T Berg from Lurie Childrens Hospital in Chicago.

Dr. Mirella Salvatore: Commentary on this year’s flu season and shares her predictions on the severity of the circulating influenza strains.

Dr. Dhruv Khullar: Stigma Against Gay People Could be Deadly

Health tech pioneer Deborah Estrin named MacArthur fellow.

Deborah Estrin, professor of computer science at Cornell Tech and of healthcare policy and research at Weill Cornell Medicine, has been awarded a 2018 MacArthur Foundation fellowship for her innovative work using mobile devices and data to address social challenges.

Dr. Dhruv Khullar: New Health Policy Briefs Examine The Intersection Of Income And Health

Health Affairs released the next set in its ongoing series of Health Policy Briefs focused on the social determinants of health. Three briefs examine the connections between income and health as well as policy solutions that have been developed to confront and address the impact of poverty on people’s well-being. Dr. Dhruv Khullar provides an overview of the issue.

Dr. Said Ibrahim: Effect of a Positive Psychological Intervention on Pain and Functional Difficulty Among Adults With Osteoarthritis. A Randomized Clinical Trial

With increasing acceptance of complementary and integrative health practices, there has been a surge of interest in using positive psychological interventions to improve the well-being of patients with chronic illness. Such interventions include activities that increase positive affect and cultivate qualities such as gratitude and kindness, and are based on theoretical and empirical work linking positive psychological skills and health.Evidence indicates that positive psychological interventions reduce depressive symptoms and increase overall well-being. Studies have begun testing the effects of positive psychological interventions in patient populations with chronic health conditions other than depression, and have started examining their effects on physical outcomes such as pain.

Dr. Dhruv Khullar: Even as the U.S. Grows More Diverse, the Medical Profession is Slow to Follow

I’ve never cared for a Hmong child, but I often think about what it would be like.

The summer before we started medical school, I and other students were advised to read Anne Fadiman’s “The Spirit Catches You and You Fall Down.”

The book chronicles the illness of Lia Lee, a Hmong girl with severe epilepsy, and her family’s saga navigating the American medical system. The Hmong come from Southeast Asia.

The story has become a symbol of the sometimes devastating consequences of a cultural divide — a cautionary tale of miscommunication, misperception and mistrust, culminating in a catastrophic two-hour seizure and permanent brain damage. Lia died in 2012, after living the last 26 years of her life in a persistent vegetative state.

It is increasingly clear that high-need, high-cost patients are not a homogenous group, but rather a diverse set of patients with varied circumstances and needs. Acting on this insight requires comprehensive data networks we have not traditionally had, and most analyses to date have focused primarily on claims data. We argue that making clinical and financial gains will require data-sharing networks that integrate clinical factors, genomic information, and social determinants from multiple health systems.

Drs. Ancker and Kaushal: Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system

Although alert fatigue is blamed for high override rates in contemporary clinical decision support systems, the concept of alert fatigue is poorly defined. We tested hypotheses arising from two possible alert fatigue mechanisms: (A) cognitive overload associated with amount of work, complexity of work, and effort distinguishing informative from uninformative alerts, and (B) desensitization from repeated exposure to the same alert over time.

Dr. Dhruv Khullar discusses his editorial, published in The New York Times, about shorter life expectancy of Americans with serious mental illnesses.

Dr. Rainu Kaushal Named One of Crain’s Notable Women in Health Care

Dr. Rainu Kaushal, chair of the Department of Healthcare Policy and Research at Weill Cornell Medicine and physician-in-chief of healthcare policy and research at NewYork-Presbyterian/Weill Cornell Medical Center, has been named one of Crain’s inaugural Notable Women in Health Care in New York City.

Dr. Arian Jung, Recipient of K01 Career Development Award from the National Institute on Aging

Dr. Arian Jung, assistant professor of Health Policy and Economics in the Department of Healthcare Policy and Research, was recently awarded a K01 career development award from the National Institute on Aging to study the quality of physician care for nursing home residents with Alzheimer’s disease and related dementias (ADRD).

“Seventy-five percent of people with Alzheimer’s disease and related dementias will be admitted to nursing homes by the age of 80, compared to 4% of the general population, and approximately 70% of individuals with ADRD will die in these facilities,” states Dr. Jung.

Dr. Fei Wang Wins Early Career Development Award from National Science Foundation

Dr. Fei Wang, an assistant professor of healthcare policy and research at Weill Cornell Medicine, received a Faculty Early Career Development Award from the National Science Foundation for his work developing computer models used to predict disease.

Dr. Dhruv Khullar: The Largest Health Disparity We Don’t Talk About

Americans with depression, bipolar disorder or other serious mental illnesses die 15 to 30 years younger than those without mental illness — a disparity larger than for race, ethnicity, geography or socioeconomic status. It’s a gap, unlike many others, that has been growing, but it receives considerably less academic study or public attention. The extraordinary life expectancy gains of the past half-century have left these patients behind, with the result that Americans with serious mental illness live shorter lives than those in many of the world’s poorest countries.

Dr. Geraldine McGinty elected 1st Woman Chair in ACR history

Dr. Geraldine McGinty, a renowned leader and expert in health care strategy and economics, has been elected Chair of the American College of Radiology (ACR). She is the 1st woman to be elected to the position in the ACR's 95 yr history.

Student Public Health Prize Winners Named

Each year the medical student recipients of the Public Health Prizes (which they receive during commencement) get their photos posted on the department’s website with a description of the prizes. This year’s winners and the descriptions are as follows:

Sasha Hernandez and Anna McKenney will share the Elise Strang L’Esperance Prize in Public Health, awarded to the female student(s) in the graduating class who best reflects the attributes and values of Dr. L’Esperance, who served on the faculty of Cornell University Medical College for over forty years.

Eric Kutscher and Paul H. McClelland will share the George G. Reader Prize in Public Health, which was endowed in 1992 by friends and colleagues of Dr. George Reader (’43), who served as Chairman of the Department of Public Health from 1972 to 1992. A cash prize is given to the graduating student(s) who, in the judgement of the Department’s faculty, shows the most promise in the field of public health.

A New York telehealth visit likely saves a heart patient’s life

A man walking in off the street to a drug store in Manhattan got key advice from a digital doctor visit that in all likelihood saved his life. In this case, it was by seeking treatment before having a fatal heart attack after a NewYork-Presbyterian/Weill Cornell Medical Center doctor during a telehealth session diagnosed the patient as having congestive heart failure.

Residents with Realistic Expectations Less Likely to Leave

Continuing coverage on Dr. Heather Yeo’s study, published in JAMA Surgery, which found that surgical interns with realistic expectations of the demands of residency and life as an attending may be more likely to complete their training.

Dr. Dhruv Khullar: We’re Bad at Evaluating Risk. How Doctors Can Help

Medicine’s decades-long march toward patient autonomy means patients are often now asked to make the hard decisions — to weigh trade-offs, to grapple with how their values suggest one path over another. This is particularly true when medical science doesn’t offer a clear answer: Doctors encourage patients to decide where evidence is weak, while making strong recommendations when evidence is robust. But should we be doing the opposite?

Research suggests that physicians’ recommendations powerfully influence how patients weigh their choices, and that while almost all patients want to know their options, most want their doctor to make the final decision. The greater the uncertainty, the more support they want — but the less likely they are to receive it.

This issue of the Annals of Family Medicine includes multiple articles reporting early information from the implementation of the US Agency for Healthcare Research and Quality (AHRQ) initiative EvidenceNOW: Advancing Heart Health in Primary care. This $112 million initiative—one of the largest in AHRQ’s history—funds 7 cross-organizational collaboratives to assist 1,500 small (fewer than 10 clinicians) primary care practices to improve their care for cardiovascular disease. Meyers et al1 provide thoughtful explanations of the ways in which AHRQ designed EvidenceNOW to navigate the trade-offs between implementation (including permitting flexibility and local adaptation) and rigorous evaluation.

The Physicians Foundation and Weill Cornell Medicine Launch New Center to Study Physician Practice and Leadership

A new research center launches today with the goal of empowering and supporting practicing physicians as they seek to improve care for their patients while navigating today’s complex healthcare landscape. The Physicians Foundation Center for the Study of Physician Practice and Leadership at Weill Cornell Medicine (CPPL) is embarking on an initial five-year initiative to document challenges facing physicians in medical practice and define practice models that help physicians to provide high-quality and high-value care to patients. The Center is made possible by a grant from The Physicians Foundation, a non-profit organization seeking to empower physicians to lead in the delivery of high-quality, cost-efficient healthcare, and contributions by Weill Cornell Medicine, one of the top-ranked clinical and medical research centers in the U.S.

RBMA 2018: McGinty Looks Back, Gears Up

Dr. Geraldine McGinty leads a session at the Radiology Business Management Association’s 2018 PaRADigm conference, where she discusses her experience in the field, payment models, AI and related data-science opportunities, and advice to radiologists.

Drs. Lawrence P. Casalino and Dhruv Khullar’s viewpoint, published in JAMA, discusses how physician practices are experimenting with ways to pool resources across groups while maintaining their independence given the current healthcare environment that is moving toward accountable care organizations (ACOs) and population health management.

Preventive Medicine RIPS

First and third Tuesday of every monthC2 Conference Room402 East 67th StreetNew York, NY 10063

NIH All of Us Research Program
The All of Us Research Program is a historic effort to collect data from one million or more people living in the United States to accelerate research and improve health,
building one of the largest health databases. By taking into account individual differences in lifestyle, environment, and biology, researchers will develop precise medicine and treatment paths catered to you. This is a collaborative consortium
project in partnership with NewYork-Presbyterian, Columbia University Medical Center, and Harlem Hospital.

NYC-CDRN Receives Funding for Phase II Work
The NYC-CDRN has been approved for a three-year, $8.5 million funding award by the Patient-Centered Outcomes Research Institute (PCORI) as part of the second phase of the development of the National Patient-Centered Clinical Research Network.

CHERISH is a multi-institutional Center of Excellence, funded by the National Institute on Drug Abuse. The Center's mission is to develop and disseminate health economic research on healthcare utilization, health outcomes, and health-related behaviors that informs substance use disorder treatment policy and HCV and HIV care of substance users. The Center is a collaboration among Weill Cornell Medicine, Boston Medical Center, the University of Pennsylvania, and the University of Miami Miller School of Medicine.

MDEpinet
MDEpiNet is a global effort bringing together all parts of the medical device ecosystem to build a national medical device evaluation system. As a Public Private partnership, MDEpiNet is working to improve and integrate real-world data infrastructure, develop appropriate methodologies, and conduct studies to improve patient-centered outcomes for medical devices around the world.